Silver Fillings | Cosmetic Dentistry

Dr. Hall:

My dentist says my upper second molar should have a silver filling or crown. I want a white filling (can’t afford a crown). He is a prosthodontist too. Should I listen to your website or listen to him?

—David from New York

Dear David:

Prosthodontists, while being highly trained, are highly trained in the old, conservative philosophy and are firmly ingrained in dental school traditions.

Do NOT push this man out of his comfort zone. My advice is, that if you’re going to have this man be your dentist, to let him do what he is comfortable doing, which is the amalgam filling. (They like to say silver and avoid any reference to mercury because saying mercury scares people. I know how they think. I had that lecture in dental school—it was nearly an entire class period in our ethics class where we were told not to make any reference to the mercury in the fillings. But there is more mercury in those fillings than silver. There is copper and some zinc, and the correct term is amalgam.)

Yes, the white filling has distinct advantages. The chief advantage, in my mind, is that you have to grind away much less of the natural tooth with the white filling. The amalgam filling requires a minimum depth of 2 millimeters, a boxed out form, and all undermined tooth structure has to be ground away. With the white filling, you just have to take out the decay and then the filling is bonded to the tooth. Some amalgam fillings require grinding away of three or four times the amount tooth structure compared to a white filling.

You may want to see photos of white filling preparations to see the dramatic difference that occurs in some cases.

But if you want the white filling, and I can’t stress this enough, you need a dentist who LIKES doing the white fillings. Those are the only ones who are good at it. Otherwise, you’re going to have trouble with the filling. Don’t ever try to push your dentist out of his or her comfort zone, for ANY procedure. It just leads to trouble. Dentists are also trained not to give the patient any clue that they are uncomfortable with any procedure and or if they feel their skills in that area are lacking. We all had that lecture in dental school. They are trained that this makes the patients uneasy, and they have to maintain that air of confidence for your sake.

My advice. I hope this is helpful.

—Dr. David Hall

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